Definition and incidence of hypotension in intensive care unit patients, an international survey of the European Society of Intensive Care Medicine

J Schenk; W H van der Ven; J Schuurmans; S Roerhorst; T G V Cherpanath; W K Lagrand; P Thoral; P W G Elbers; P R Tuinman; T W L Scheeren; J Bakker; B F Geerts; D P Veelo; F Paulus; A P J Vlaar; Cardiovascular Dynamics Section of the ESICM

doi:10.1016/j.jcrc.2021.05.023

Definition and incidence of hypotension in intensive care unit patients, an international survey of the European Society of Intensive Care Medicine

J Crit Care. 2021 Oct:65:142-148. doi: 10.1016/j.jcrc.2021.05.023. Epub 2021 Jun 18.

Authors

Affiliations

¹ Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands.
² Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, Netherlands.
³ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Intensive Care, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Infection and Immunity, de Boelelaan 1117, Amsterdam, Netherlands.
⁴ University Medical Center Groningen, University of Groningen, Department of Anesthesiology, Groningen, Netherlands.
⁵ New York University Langone Medical Center, New York University Langone Health, Department of Pulmonary and Critical Care, New York, USA; Columbia University Medical Center, Columbia University, Department of Pulmonology and Critical Care, New York, USA; Erasmus MC University Medical Center, Erasmus University, Department of Intensive Care, Rotterdam, Netherlands; Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Departamento de Medicina Intensiva, Santiago, Chile.
⁶ Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands.
⁷ Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands. Electronic address: a.p.vlaar@amsterdamumc.nl.

PMID: 34148010
DOI: 10.1016/j.jcrc.2021.05.023

Abstract

Introduction: Although hypotension in ICU patients is associated with adverse outcome, currently used definitions are unknown and no universally accepted definition exists.

Methods: We conducted an international, peer-reviewed survey among ICU physicians and nurses to provide insight in currently used definitions, estimations of incidence, and duration of hypotension.

Results: Out of 1394 respondents (1055 physicians (76%) and 339 nurses (24%)), 1207 (82%) completed the questionnaire. In all patient categories, hypotension definitions were predominantly based on an absolute MAP of 65 mmHg, except for the neuro(trauma) category (75 mmHg, p < 0.001), without differences between answers from physicians and nurses. Hypotension incidence was estimated at 55%, and time per day spent in hypotension at 15%, both with nurses reporting higher percentages than physicians (estimated mean difference 5%, p = 0.01; and 4%, p < 0.001).

Conclusions: An absolute MAP threshold of 65 mmHg is most frequently used to define hypotension in ICU patients. In neuro(trauma) patients a higher threshold was reported. The majority of ICU patients are estimated to endure hypotension during their ICU admission for a considerable amount of time, with nurses reporting a higher estimated incidence and time spent in hypotension than physicians.

Keywords: Blood pressure; Critical care; Hypotension; Intensive care units; Surveys and questionnaires.

MeSH terms

Critical Care
Humans
Hypotension* / epidemiology
Incidence
Intensive Care Units*
Surveys and Questionnaires